预计结肠直肠癌发病率和死亡率基于观察到的结肠镜检查和基于排列便的查
Reinier G S Meester1, Iris Lansdorp-Vogelaar1, Sidney J Winawer2
1Public Health Department, Erasmus MC, Rotterdam, the Netherlands.
The American journal of gastroenterology
|February 6, 2024
概括
每10年一次的查结肠镜检查比每年一次的便隐性血液检查更有效地减少结肠直肠癌的发病率和死亡率,特别是当粘附率低于最佳时. 这项研究强调了选试验有效性遵守的重要性.
科学领域:
- 胃肠病学 胃肠病学
- 预防医学 预防医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 结肠直肠癌 (CRC) 查模型通常假定完美遵守,但现实世界的遵守影响长期有效性.
- 查结肠镜和便测试 (如便隐性血液测试 (FOBT)) 的观察到的依从率有显著差异.
- 在现实的遵守场景下,CRC查策略的比较有效性尚未得到充分理解.
研究的目的:
- 评估每10年一次查结肠镜检查的长期有效性,与使用观察到的顺序粘附数据进行每年高灵敏度瓜亚克基便隐性血液检测 (HSgFOBT) 相比.
- 为了比较不同查策略之间的CRC发病率和死亡率,在不同的坚持水平下.
- 通过评估遵守对CRC预防的影响,为查建议提供信息.
主要方法:
- 采用微观模拟选分析 (MISCAN) 模型,结合从国家结肠镜研究中观察到的顺序选依从性数据.
- 在没有查的情况下,在15年内比较CRC发病率和死亡率,每10年一次查结肠镜检查,每年一次HSgFOBT.
- 模拟的场景与100%的坚持和差异性观察到的坚持率对两个查方式.
主要成果:
- 在没有查的情况下,模拟的CRC发病率和死亡率在15年内每1000名参与者中分别为20.9和6.9.
- 在100%的遵守率下,查结肠镜比HSgFOBT更多地降低了发病率,而两者同样降低了死亡率.
- 查结肠镜 (83.6%) 观察到的坚持率高于HSgFOBT (49.1%到第4轮),导致与HSgFOBT相比,结肠镜的模拟CRC发病率和死亡率显著降低.
结论:
- 每10年一次的查结肠镜检查显示,在减少CRC发病率和死亡率方面,与年度HSgFOBT相比,在考虑到观察到的低于最佳的坚持时,其效率更高.
- 这些发现强调了在CRC查测试的现实世界性能中遵守的关键作用.
- 结肠镜检查可能是首选的,当顺序便测试的坚持是不理想的,结肠镜检查是可访问和可接受的.
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